Cardiac Advanced Life Support (CALS) in Cardiac Arrest

Initial Assessment and Basic Life Support

• The American Heart Association recommends checking for responsiveness, breathing, and pulse simultaneously (within 10 seconds) 1
• High-quality chest compressions should be started immediately if no pulse is detected, with a rate of 100-120 compressions per minute and a depth of at least 2 inches/5 cm in adults 1, 2, 3, 4
• The compression-to-ventilation ratio should be 30:2 if no advanced airway is in place 1, 2

Rhythm Assessment and Defibrillation

• The American Heart Association recommends pausing briefly to check rhythm after 2 minutes of CPR, and delivering one shock immediately for shockable rhythms (VF/pVT) with a biphasic dose of 120-200J or a monophasic dose of 360J 1, 3, 4
• For non-shockable rhythms (PEA/asystole), CPR should be continued without defibrillation, with reassessment of rhythm every 2 minutes 1, 3

Vascular Access and Medication Administration

• The American Heart Association recommends establishing IV/IO access while CPR is ongoing, and administering epinephrine 1 mg IV/IO every 3-5 minutes for all rhythms 3, 4
• For persistent or recurrent VF/pVT after initial shock, amiodarone 300 mg IV/IO or lidocaine 1-1.5 mg/kg IV/IO may be administered 3, 6

Advanced Airway Management

• The American Heart Association recommends considering advanced airway placement (endotracheal intubation or supraglottic airway) and confirming placement with waveform capnography 3, 7
• Once an advanced airway is placed, continuous chest compressions should be provided without pauses for ventilation, with 1 breath every 6 seconds (10 breaths/min) asynchronously with compressions 3, 7

CPR Quality and Team Dynamics

• The American Heart Association recommends changing compressors every 2 minutes (or sooner if fatigued) to maintain high-quality compressions, and monitoring CPR quality using quantitative waveform capnography if available 3, 4, 6

Identifying and Treating Reversible Causes

• The American Heart Association recommends considering and treating potential reversible causes (the "H's and T's"), including hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade (cardiac), toxins, thrombosis (pulmonary), and thrombosis (coronary) 3

Post-Resuscitation Care

• The American Heart Association recommends beginning post-cardiac arrest care upon return of spontaneous circulation (ROSC), including monitoring for signs of ROSC and considering targeted temperature management for patients who do not follow commands after ROSC 3, 5, 6, 9